Age Friendly Cities and China’s Competition to Invent Sustainable Health

Almost 20 years ago, in my first job out of graduate school for Paul Allen, the co-founder of Microsoft, I worked on a project called “ElderSpace.” Our team of social scientists at this Silicon Valley think tank set out to study the needs of the staff and residents of a nearby nursing home, in hopes of discovering ways in which technology could improve their lives. Months later, having built a wide range of working prototypes—from wireless heart monitors and weight scales to rich video conferencing “walls” that allowed seniors to sit and chat with loved ones virtually—we put on a demo day of our ideas. During one of the feedback sessions about these prototypes, one of the executives said, “You know, we shouldn’t be trying to figure out how to build a better nursing home but how to get rid of nursing homes in society through the invention of new technologies.”

Without my realizing it at the time, that nagging question set me off on a 20-year (so far) journey to figure out how technologies might help to promote independence, choice, and a great quality of life for seniors wherever they choose to age-in-place. And after two decades of prototypes, policy advocacy, and product launches, I have to admit that our society is still all too ready to stash older people away in institutions or alone in their own homes because we have not yet figured out how to build a thriving, sustainable, multi-generational community where the predominance of people over age 65 can thrive. And we have failed to develop new care models—supported by new technologies—that help those older people to have affordable access to healthcare as they deal with the infirmities, injuries, and chronic conditions that so often come with age.

So it was, admittedly, with some amount of skepticism almost two years ago when I first met with a Chinese delegation from the Minister of Social Affairs and the Minister of Health offices to discuss how they might build whole new communities—cities even—that were designed for aging-in-place. I understood the consequences of China’s one-child policy resulting in a demographic challenge to find enough younger people to care for a swiftly aging society. And I had seen those amazing photos that showed the urbanization of China, as their government built entirely new thriving cities on former tracts of farmland almost overnight. Also shocking were the charts showing the growth of the middle class in China, with its new expectations for different levels of access and service for healthcare. But to truly design and build an “age friendly city” seemed impossible—almost science fiction.

But now, as we approach the official launch of China’s Age Friendly Cities initiative, I can see a nation that is truly committed to answering that two-decade question that has plagued me: how do we use new technologies (and policies and care models) to promote healthy and independent living for older people? Over the past year, our Intel team in China has worked closely with key government stakeholders, academics, and companies to begin to lay out a plan for how to achieve this audacious vision. In particular, we have begun to work with eco-system partners to design the blueprint for building a sustainable healthcare “grid” and “careforce” that will allow this city to deliver care into the homes and community locations of its citizens instead of in expensive, unsustainable hospitals, nursing homes, and other institutions.

The “healthcare grid” will be a lattice work of intelligent communications, computing, and health IT technologies—with billions of dollars of stimulus from the Chinese government—designed to enable remote patient monitoring, care coordination, personalized coaching, social networking, caregiver support, and accessibility and engagement by seniors in the flow of daily life in their city. Key to success will be ensuring that the healthcare grid, transportation grid, energy grid, communications grid, and other city infrastructures are designed to be interoperable and to promote and support independence whenever possible. Think of this as “grid convergence,” where all aspects of city life are built upon a common, scalable infrastructure that serves a wide range of needs. This is in sharp contrast with the model today that most cities use, whereby piecemeal design and funding of different “grids” at different times leads to fragmentation, redundancy, and inefficient use of public resources.

For example, the home energy management solutions must be able to not only reduce power consumption to protect the environment and keep power bills affordable, but that energy usage data can also become part of an activities-of-daily-living monitoring system to make sure Mom or Dad are doing okay. Similarly, the intelligence in the transportation grid should help older people to safely and successfully navigate the public transportation system so that they are able to be active and mobile in the community. And the broadband infrastructure must support not only high-definition movies for entertainment purposes, but also high-definition, multi-party video conferences between a chronic disease patient at home with her daughter, doctor, and neighbor simultaneously. Sustainable health will require all of these elements coming together in a well-designed and intentional way to promote independence.

These—and many other experiences—will be possible in China’s Age Friendly City because of the purposeful design of technologies, policies, and workforce training that support team-based care models and independent living at home. Sure, there will be a small hospital in the community for the most extreme, emergency situations that always occur, but the use of institutions for care will become the exception, not the norm. Planning out a sustainable health system from the ground up will allow the Chinese government to achieve the “triple aims” of health reform—better quality, access, and costs—that almost every nation is striving for. And in China, it’s on a scale that most countries cannot begin to imagine because our legacy healthcare paradigms (and reimbursement models) are so institutionally heavy.

This audacious vision, investment, and action plan to make Age Friendly Cities a reality, not just a concept on paper and in prototypes, will put China in a global leadership position that is hard to compete with. The knowledge that the Chinese people and companies will gain from these initiatives will fuel entire new applications, intellectual property, and industries, helping them not only to solve their own sustainable health challenges but also to export new goods and services to the rest of the world that is also dealing with the consequences of global aging. They don’t have to get it all “right” the first time—they just have to get started, to learn, and then to iterate.

For two decades, I have preached about the need to invent “gray technologies” and “gray jobs” for global aging—much as nations have created “green technologies” and “green jobs” for global warming—but now China is about to deliver upon that promise. As a global entrepreneur, I am honored and excited to have my Intel team at the table…collaborating, learning, teaching, inventing, revising, and rethinking old notions of hospitals, nursing homes, and clinics. As a U.S. citizen, I can only hope that these kinds of approaches will begin to take hold so that my own family—and so that I myself—might have these options as we age. May the global competition to invent independence—to achieve sustainable health—begin. As far as I can tell, China’s efforts put it far ahead of a very hungry, needy pack.